EMS World

AUG 2011

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 31 of 71

ASSESSMENT TIPS removing clothing and maximizing passive cooling through radiation and evaporative heat loss. Moving the patient to a cool environment, and, if nausea is not present, encouraging the patient to rehydrate with a cool, electro- lyte-containing solution such as a sports drink is usually suffi cient. In heat stroke, far more aggressive cooling measures are necessary. Wrap the patient in moist sheets and blow cool air over them to maximize convec- tive and evaporative heat loss. Ice packs to the groin, axillae, head and neck may be useful. Cold-Related Emergencies When the body’s thermoregulatory mechanisms can no longer produce enough heat to overcome passive heat loss, hypothermia (<95°F or 35°C) occurs. Unlike frostbite, which is local- ized, hypothermia affects all organ systems and tissues. Just as with heat-related emergen- cies, children and the elderly are at greatest risk of hypothermia due to their less effi cient thermoregulatory capacity. Children have larger body surface-area- to-mass ratio, compounding heat loss through the skin, while elderly patients often have less subcutaneous fat for insulation or may be taking medica- tions that inhibit the body’s ability to withstand temperature extremes. Alcohol ingestion increases risk of cold- related emergencies. Classifi cation of hypothermia is based upon core temperature: • Mild hypothermia (90°–95°F or 32°–35°C) presents with the typical fi ght-or-fl ight response as the body releases epinephrine and norepi- nephrine to increase basal metabolic rate, and thus heat. Shivering, tachy- pnea, tachycardia, hypertension and peripheral vasoconstriction may all be present. • Moderate hypothermia (82°– 90°F or 28°–32°C) presents with more violent shivering; confusion begins, and fi ne motor skills deterio- rate. Skin will be cold, and lips, ears and nailbeds may appear cyanotic. • Severe hypothermia (68°–82°F or 20°–28°C) presents with increasing neurological impairment, beginning with sluggish thinking, diffi culty speaking and amnesia, and progressing to stupor and coma. Fine motor skills are absent or severely impaired, and motor coordination begins to dete- riorate. Heart rate and breathing slow dramatically, although tachydysrhyth- mias such as atrial fi brillation are not uncommon. Clinical death may occur, although due to the slowed cellular activity, full neurological recovery may still be possible even after prolonged resuscitation attempts. • Profound hypothermia (<68°F or 20°C) invariably presents with clin- Proud To Be American Made Selectable Drop Chamber I.V. Set We are in the business of saving lives. It is a responsibility we take very seriously. For More Information Circle 16 on Reader Service Card 32 AUGUST 2011 | EMSWORLD.com See Us at EMS Expo Booth #3812

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